Crohn病の腸病変の長期経過

Long-term Clinical Course of Crohn's Disease: Study on Changes of Lesions in Radiological Findings in Cases Followed-up More Than 10 Years

要旨　Crohn病（Crohn's disease; CD）患者の長期経過を，手術率，病変の推移の面から検討した．当院消化器内科で十分経過を追えた症例83例を対象とした．その中で死亡症例が4例，アミロイドーシス合併症例が5例みられた．手術症例は46例で累積手術率は5年目30.3％，10年目45.5％，15年目73.7％だった．再手術例は14例で累積再手術率は3年目12.5％，5年目43.5％，10年目69.2％だった．手術後1年以内に，口側に敷石像や縦走潰瘍を48％に認め，その中で73％が再手術となった．腸管吻合を側々吻合で施行された症例には吻合部狭窄を来した例はなかった．10年以上経過観察し，定期的に画像検査を行った31例を対象にして，病変の推移をみた．発症初期に敷石像を認めた症例は，小腸で17例55％，大腸に12例39％で，10年目までにそれぞれ8例47％，6例50％が手術された．縦走潰瘍を認めた例は小腸，大腸とも7例23％で，その中でそれぞれ1例手術となった．

　On patients with Crohn's disease in eighty-three patients with Crohn's disease, in which the clinical course could be observed well at our clinic from April 1972 to April 1999, we studied the probability rate of need for surgery and chronological changes inradiological findings. Four patients among a total of 83 patients died, and five patients were complicated with amyloidosis. The probability that surgery would be needed five, ten and fifteen years after onset of symptoms was 30.3％, 45.5％ and 73％, respectively. Our data shows that the probability that a further operation would be needed three, five and ten years after the first operation was 12.5％, 43.5％ and 69.2％ respectively. Recurrence caused by cobblestone appearance and longitudinal ulcer on the non-resected small bowel was recognized in 11 of 23 patients. 8 patients (73％) of these 11 patients received a second resection. In 17 cases in the small intestine and 12 cases in the large intestine cobblestone appearance was visualized in radiographic findings, 8 cases of 17 cases and 6 cases of 12 cases developed into narrowing, stenosis and formation of fistulas and required surgery.